Severe Acute Respiratory Syndrome Outbreak Research Articles

Building the National SARS-CoV-2 Laboratory Diagnostic Capacity in Taiwan.

Through early and proactive laboratory testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes novel coronavirus 2019, Taiwan has demonstrated an efficient and rapid control response to contain the outbreak. Two days after the World Health Organization announced the complete viral genome sequence, the national laboratory of the Taiwan Centers for Disease Control developed a specific real-time reverse transcription polymerase chain reaction (real-time RT-PCR) test for SARS-CoV-2. The national laboratory network was further strengthened through the recruitment of medical centers and regional hospitals distributed throughout most geographical regions of the country. Ultimately, a network of 60 laboratories with a capacity of 7,342 real-time RT-PCR tests per day was established. Between January 14 and August 5, 2020, a total of 158,772 tests were conducted, corresponding to 120,487 cases. Test results were obtained within 24 hours, enabling an efficient and rapid control response.

Age Moderates Perceived COVID-19 Disruption on Well-Being.

Background and ObjectivesIt is not fully understood how large-scale events affect well-being. Older adults showed the highest levels of resilience following the September 11th (9/11) terrorist attacks, but during the severe acute respiratory syndrome (SARS) outbreak there were no age-related differences in well-being. The current study examined the Coronavirus Disease 2019 (COVID-19) disruption on well-being throughout adulthood.Research Design and MethodsPerceived stress and affect were examined in 166 community-dwelling adults (Mage=35.65; SD=15.53; range=18-79) in relation to the perceived disruption of the COVID-19 pandemic to their lives.ResultsA significant moderation was found for age and COVID-19 disruption on perceived stress [F(5, 153) = 8.88, p & .05, R2= .22] and negative affect [F(5, 154) = 4.91, p & .05, R2= .14], but not for positive affect. For participants over 50, those who rated COVID-19 as a low or high disruption had similar scores on stress and negative affect, but with younger aged participants, perceiving high disruption corresponded with higher levels of stress and negative affect.Discussion and ImplicationsFindings are consistent with the strength and vulnerability integration (SAVI) model, wherein older adults try to maintain positive emotional well-being; with middle-aged and older adults in the current study having experienced less negative impact on well-being. Middle-aged and older adults may be better able to regulate negative emotions, from COVID-19, than younger adults. SAVI proposes a greater negative impact on older adults when they experience sustained stressors; as the challenges with COVID-19 continue, further data will need to be examined.

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education.

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education.

Reader response: Neurologic complications of coronavirus infections.

Dr Nath's timely editorial1 lists the neurologic complications of coronavirus infections. On behalf of coauthors, I highlight 5 patients with large artery stroke in the 2003 severe acute respiratory syndrome (SARS) outbreak in Singapore, arising from SARS-CoV-1 virus infection.2 Of 206 patients, 48 required intensive care and 32 died. Four of the 5 patients with stroke were critically ill and 3 died. The strokes were deemed thromboembolic. At autopsy, 1 patient had occipital lobe infarction, sterile vegetations in multiple valves, deep venous thrombosis, and pulmonary embolism; this prompted low-molecular-weight heparin (LMWH) use in subsequent critically ill patients with SARS. Nevertheless, a significant number of patients suffered venous thromboembolism, despite adequate treatment with LMWH.3 Three patients received intravenous immunoglobulin (IVIg) empirically, which might have contributed to stroke. The induction of hfgl2 prothrombinase gene by SARS-CoV-1 in experiments raised the possibility of a direct prothrombotic effect of that coronavirus.4 Only 8 patients underwent autopsy; therefore, more strokes may have gone undiagnosed. It is easy to miss stroke in critically ill patients who are heavily sedated and paralyzed. With increasing anecdotal reports ([journals.lww.com/neurotodayonline][1]), and the use of IVIg in desperately ill patients with COVID-19,5 we reiterate vigilance against strokes and thrombotic complications in critically ill coronavirus infected patients. [1]: https://journals.lww.com/neurotodayonline

COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics.

The novel coronavirus disease 2019 (COVID-19) outbreak started in early December 2019 in the capital city of Wuhan, Hubei province, People's Republic of China, and caused a global pandemic. The number of patients confirmed to have this disease has exceeded 9 million in more than 215 countries, and more than 480 600 have died as of 25 June 2020. Coronaviruses were identified in the 1960s and have recently been identified as the cause of a Middle East respiratory syndrome (MERS-CoV) outbreak in 2012 and a severe acute respiratory syndrome (SARS) outbreak in 2003. The current SARS coronavirus 2 (SARS-CoV-2) is the most recently identified. Patients with COVID-19 may be asymptomatic. Typical symptoms include fever, dry cough and shortness of breath. Gastrointestinal symptoms such as nausea, vomiting, abdominal pain and diarrhoea have been reported; neurologically related symptoms, particularly anosmia, hyposmia and dysgeusia, have also been reported. Physical examination may find fever in over 44% of patients (and could be documented in over 88% of patients after admission), increased respiratory rate, acute respiratory disease and maybe decreased consciousness, agitation and confusion. This article aims at presenting an up-to-date review on the pathogenesis, diagnosis and complications of COVID-19 infection. Currently no therapeutics have been found to be effective. Investigational therapeutics are briefly discussed.

Defining COVID-19 as a Disaster Helps Guide Public Mental Health Policy.

The coronavirus disease (COVID-19) pandemic continues to be a devastating chapter in history. The consequences of the pandemic unfold daily and they extend beyond physical health. Current research suggests that it is a public mental health crisis. With regard to the physical effects of COVID-19, policy-makers have drawn from past experiences, such as the severe acute respiratory syndrome (SARS) outbreak of 2003, to craft unique responses. A similar approach must be taken to address the mental health effects of the pandemic. Because COVID-19 can fit the definitions of a mental health disaster, it can be addressed using the principles of disaster mental health management. This letter to the editor presents arguments for defining COVID-19 as a mental health disaster, the challenges facing policy-makers in addressing it as such, and calls upon researchers to fill this gap in the literature.

Appearances Can Be Deceiving - Viral-like Inclusions in COVID-19 Negative Renal Biopsies by Electron Microscopy.

Since the discovery of the causative agent for the novel severe acute respiratory syndrome (SARS)–like pneumonia syndrome pandemic that started in China in 2019 (1,2), a coronavirus named SARS coronavirus 2 (SARS-CoV-2), electron microscopy images have populated the medical literature (2) and media outlets alike displaying the characteristic 60–140 nm round particles surrounded by a “corona” of 9–12 nm distinctive spikes (2). Although many of these images were obtained after “ in vitro ” infection of cultured cells with SARS-CoV-2 (2) and are thus likely a true representation of viral particles, we have observed morphologically indistinguishable inclusions within podocytes and tubular epithelial cells both in patients negative for coronavirus disease 2019 (COVID-19) as well as in renal biopsies from the pre–COVID-19 era. Although direct infection of the kidney is theoretically possible, given the presence of angiotensin-converting enzyme 2 (the receptor used by SARS-CoV-2 to gain access to cells) within proximal tubular epithelium (3) and podocytes (4), the virus has not been detected by real-time RT-PCR in urine samples from patients with COVID-19 (5⇓–7). Additionally, for the virus to have access to kidney parenchyma, viremia should occur, and this has only been detected in a minority of patients (6⇓–8). We would, therefore, like to issue a note of caution for inferring viral tissue infection by morphology alone using electron microscopy images from tissues obtained from biopsies or autopsy material in patients with COVID-19. Moreover, caution should be used when interpreting immunohistochemical results, especially within proximal tubules, which are prone to nonspecific staining by a variety of antibodies due to their intense reabsorptive capacity. Additionally, more specific techniques such as immunoelectron microscopy using specific viral antigens (9), or in situ hybridization for viral RNA, are likely necessary to undoubtedly confirm tissue infection in …

Adaptations of a Tertiary Otorhinolaryngology Head and Neck Surgery Department in Singapore during the COVID-19 Outbreak.

Purpose:The novel coronavirus 2019 (COVID-19) outbreak which was first reported in Wuhan, China has been declared a pandemic by the World Health Organization on March 11, 2020. Otorhinolaryngologists deal intimately with pathologies of the head and neck region and upper respiratory tract and have been reported as a vulnerable group of healthcare workers who may be more susceptible to COVID-19 nosocomial infection.Methods:In this article, we provide a comprehensive overview of the adaptations of Singapore’s largest tertiary Otorhinolaryngology department during the COVID-19 outbreak. This was undertaken via an evidence-based approach. The relevant medical literature and evidence underlying our adaptations are highlighted.Results:A four-pronged strategy including (1) personnel segregation, (2) triaging and decantment, (3) use of personal protective equipment and (4) changes in clinical practice was employed. The strategy was bolstered by drawing upon a collective learnt experience from the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak.Conclusion:A rigorous framework which can preserve operationality while navigating the heightened risks during this outbreak is critical for every Otorhinolaryngology department. As the pandemic continues to evolve and more scientific reports of this disease are made available, approaches will need to be morphed.

Perspectives of medical students on local medical education during COVID-19.

Perspectives of medical students on local medical education during COVID-19.

Clinical trials in the time of a pandemic.

The first rumblings about a new coronavirus spreading in China were heard in January 2020. By the end of that month, the World Health Organization, recognizing the severity of the disease and the potential for global spread, had declared a public health emergency. By February 2020, cases had been identified in multiple countries, clinical trials of treatments with some biological plausibility had begun in China, and the initial steps of vaccine development were underway. In mid-March, by which time countries around the world were experiencing rapidly increasing numbers of cases and deaths, the World Health Organization categorized the outbreak as a pandemic. This new coronavirus was designated SARS-COV-2 in recognition of its similarity to the coronavirus responsible for the severe acute respiratory syndrome outbreak in 2002-2003. The race is on to develop treatments that can mitigate the severe consequences of infection and vaccines that can prevent infection and/or diminish the severity of disease in those who do get infected. Many challenges face these development efforts. Some are similar to those faced in the past; others are new. The urgency of finding ways to treat, and ultimately prevent, the consequences of this new and potentially deadly infection has led to unprecedented focus on clinical trials.

The Spatial Allocation of Hospitals With Negative Pressure Isolation Rooms in Korea: Are We Prepared for New Outbreaks?

Background: Allocation of adequate healthcare facilities is one of the most important factors that public health policymakers consider when preparing for infectious disease outbreaks. Negative pressure isolation rooms (NPIRs) are one of the critical resources for control of infectious respiratory diseases, such as the novel coronavirus disease 2019 (COVID-19) outbreak. However, there is insufficient attention to efficient allocation of NPIR-equipped hospitals. Methods: We aim to explore any insufficiency and spatial disparity of NPIRs in South Korea in response to infectious disease outbreaks based on a simple analytic approach. We examined the history of installing NPIRs in South Korea between the severe acute respiratory syndrome (SARS) outbreak in 2003 and the Middle East respiratory syndrome coronavirus (MERS-Cov) in 2015 to evaluate the allocation process and spatial distribution of NPIRs across the country. Then, for two types of infectious diseases (a highly contagious disease like COVID-19 vs. a hospital-based transmission like MERS-Cov), we estimated the level of disparity between NPIR capacity and demand at the sub-regional level in South Korea by applying the two-step floating catchment area (2SFCA) method. Results: Geospatial information system (GIS) mapping reveals a substantial shortage and misallocation of NPIRs, indicating that the Korean government should consider a simple but evidence-based spatial method to identify the areas that need NPIRs most and allocate funds wisely. The 2SFCA method suggests that, despite the recent addition of NPIRs across the country, there should still be more NPIRs regardless of the spread pattern of the disease. It also illustrates high levels of regional disparity in allocation of those facilities in preparation for an infectious disease, due to the lack of evidence-based approach. Conclusion: These findings highlight the importance of evidence-based decision-making processes in allocating public health facilities, as misallocation of facilities could impede the responsiveness of the public health system during an epidemic. This study provides some evidence to be used to allocate the resources for NPIRs, the urgency of which is heightened in the face of rapidly evolving threats from the novel COVID-19 outbreak.

Living Through COVID-19: A Perspective From Hong Kong

Hong Kong has been affected by the new coronavirus (COVID-19) since January 2020, almost 3 months earlier than most of the places around the globe. Once the epicenter of the severe acute respiratory syndrome (SARS) outbreak, the people of Hong Kong learned from their painful past and responded to the current epidemic quickly and accordingly. The creativity, mobility, compassion, and resilience demonstrated by Hong Kongers are understood and discussed through Viktor Frankl’s paradigm of the meaning triangle. The influence of COVID-19 on clinical practice, particularly the wearing of face masks during face-to-face therapy sessions is also briefly discussed.

Propagation of Epidemics' Economic Impacts via Production Networks: The Cases of China and ASEAN during SARS and COVID-19

Two decades after the severe acute respiratory syndrome (SARS) outbreak, Asia is confronted with the coronavirus disease 2019 (COVID-19) that has significantly affected the region's economy. In a novel general equilibrium model, we introduce epidemiological dynamics to the production network between China and the Association of Southeast Asian Nations (ASEAN). In this model, agents' risk-averse behavior during pandemics leads to shifting demands across economic sectors. We calibrate the model with the Organisation for Economic Co-operation and Development (OECD) inter-country input-output tables for pre-SARS and pre-COVID-19 periods and control for disease dynamics across years. Findings show that in the absence of policy interventions, China's greater significance in global value chains is associated with substantial economic impacts, within China and the ASEAN region. Our sensitivity analyses further show that China's containment efforts reduce the spillover effects on ASEAN.

Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan.

Because of its proximity to and frequent travelers to and from China, Taiwan faces complex challenges in preventing coronavirus disease (COVID-19). As soon as China reported the unidentified outbreak to the World Health Organization on December 31, 2019, Taiwan assembled a taskforce and began health checks onboard flights from Wuhan. Taiwan’s rapid implementation of disease prevention measures helped detect and isolate the country’s first COVID-19 case on January 20, 2020. Laboratories in Taiwan developed 4-hour test kits and isolated 2 strains of the coronavirus before February. Taiwan effectively delayed and contained community transmission by leveraging experience from the 2003 severe acute respiratory syndrome outbreak, prevalent public awareness, a robust public health network, support from healthcare industries, cross-departmental collaborations, and advanced information technology capacity. We analyze use of the National Health Insurance database and critical policy decisions made by Taiwan’s government during the first 50 days of the COVID-19 outbreak.

COVID-19 and SARS - Learnings from Two Health Systems: Australia and Canada.

As a chief nurse in Ontario during the severe acute respiratory syndrome (SARS) outbreak in 2003, I never thought I would experience anything even remotely similar, let alone exponentially worse, in my lifetime. Seventeen years and almost 17,000 km later, the COVID-19 crisis feels eerily similar in many ways, and completely different in others.

The immune system's fight against the Coronavirus; convalescent plasma from Covid-19 survivors may be used to treat patients and protect those at risk

Severe Acute Respiratory Syndrome (SARS) and Coronavirus (Covid-19) outbreak are creating emergency in public health sector. Using antiviral, antimalarial and vaccine are still under investigations, so Convalescent plasma therapy for Covid-19 is a current option because it has been succeeded in other Coronaviruses before. This work will discuss what is the Covid-19? What is the source of Covid-19? Is it transmitted from animal to human? And will discuss the convalescent plasma (CP) as a therapy for Covid-19.

Coronavirus disease 2019 (COVID-19): latest developments in potential treatments.

Many viral respiratory infections can cause severe acute respiratory symptoms leading to mortality and morbidity. In the spring of 2003, the severe acute respiratory syndrome (SARS) outbreak caused by SARS-CoV spread globally. In the summer of 2012, the Middle East respiratory syndrome (MERS) outbreak caused by MERS-CoV occurred in Saudi Arabia. In the winter of 2019, the coronavirus disease 2019 (COVID-19) outbreak caused by a novel coronavirus SARS-CoV-2 occurred in China which rapidly spread worldwide causing a global pandemic. Up until 27 May 2020, there are 5.5 million confirmed cases of COVID-19 and 347,587 COVID-19 related deaths worldwide, and there has also been an unprecedented increase in socioeconomic and psychosocial issues related to COVID-19. This overview aims to review the current developments in preventive treatments and therapies for COVID-19. The development of vaccines for SARS-CoV-2 is ongoing and various clinical trials are currently underway around the world. It is hoped that existing antivirals including remdesivir and lopinavir-ritonavir might have roles in the treatment of COVID-19, but results from trials thus far have not been promising. COVID-19 causes a mild respiratory disease in the majority of cases, but in some cases, cytokine activation causes sepsis and acute respiratory distress syndrome, leading to morbidity and mortality. Immunomodulatory treatments and biologics are also being actively explored as therapeutics for COVID-19. On the other hand, the use of steroidal and nonsteroidal anti-inflammatory drugs (NSAIDs) has been discouraged based on concerns about their adverse effects. Over the past two decades, coronaviruses have caused major epidemics and outbreaks worldwide, whilst modern medicine has been playing catch-up all along.

Reflections on COVID-19 and the ethical issues for healthcare providers

PurposeHealthcare governance places medical ethics at the forefront of defining and maintaining the quality of care. Examples of serious ethical issues include sexual abuse of patients (Dubois, Walsh, Chibnall et al., 2017), criminal prescription of opioids (Johnson, 2019) and unnecessary surgical procedures (Tayade and Dalvi, 2016) or shortages in service delivery because of little knowledge or experience especially during pandemic outbreaks (Hay-David et al., 2020). In many cases involving medical ethics, patients are identified as the first victims; however, this study aimed to consider clinicians and other healthcare practitioners as other probable victims (Ozeke et al., 2019).Design/methodology/approachThe World Health Organization (WHO) estimates that tens of millions of patients worldwide suffer disabling injuries or death every year due to unsafe medical practices and services. Nearly, one in ten patients is harmed due to preventable causes while receiving health care in well-funded and technologically advanced hospital settings (WHO, 2016). Much less is known about the burden of unsafe care in non-hospital settings, where most healthcare services are delivered (Jha et al., 2013). Furthermore, there is little evidence concerning the burden of unsafe care in developing countries, where the risk of harm to patients is likely to be greater, due to limitations in infrastructure, technologies and human resources (Elmontsri et al., 2018).FindingsWhile these problems are endemic in health care, they are exacerbated in times of health and social crises such as the coronavirus disease of 2019 (COVID-19) pandemic. This pandemic has few precedents, being most closely paralleled with the global influenza pandemic of 1918 (Terry, 2020). Initially compared to the severe acute respiratory syndrome (SARS) outbreak of 2002–2003 (Parrym, 2003), COVID-19 is already proving much more deadly. The WHO’s estimates of the number of SARS cases from the start of the outbreak in 2002, until it was brought under control in July 2003, was 8,437 cumulative cases, with 813 deaths (WHO, 2003). The European Center for disease prevention and Control estimated that as of May 15, 2020, that 4,405,680 cases of COVID-19 have been reported with 302,115 deaths (ECDC, 2020)Research limitations/implicationsThe outbreak of COVID-19 was declared in February 2020 in the Islamic Republic of Iran, and up to March 2020, the cases of morbidity reached 12,729, with 611 deaths (Bedasht, 2020). The current figure at the time of editing (May 16, 2020) is 118,392 cases, with 6,937 deaths (Worldometer, 2020). Acting in cognizance of its ethical responsibility to the citizens of Iran, the Iranian government has taken the following action to attempt to mitigate the deleterious effects of the virus: in each province, one or more hospitals have been evacuated and allocated to patients with pulmonary problems with suspected to COVID-19. Access to intensive care units and specialist equipment is a primary ethical issue that concerns the Iranian healthcare system. The issue is exacerbated by the knowledge that these facilities are not distributed equitably in the country. Therefore, equity is the first ethical concern in this situation.Practical implicationsAll nurses, clinicians, practitioners and specialists have been asked to volunteer their services in hospitals in the most infected areas. This raises ethical concerns about access to personal protective equipment (PPE) such as appropriate masks, gowns, gloves and other equipment to protect healthcare workers from infection. Access to PPE was restricted because of government failure to stockpile the necessary amount of disposable medical equipment. This was related to lack of domestic capacity to produce the equipment and problems accessing it internationally due to political-economic sanctions that were imposed on Iran by the USA and some European countries. Such shortages can quickly lead to a catastrophic situation; current evidence demonstrates that about 40% of healthcare workers are vulnerable to the COVID-19 infection (Behdasht, 2020). However, it should be noted that this is not a problem limited to Iran. As of March 2020, the WHO was already warning about PPE shortages and the dangers this posed for healthcare workers around the world (WHO, 2020).Social implicationsA Disaster Committee was created by the Iranian Ministry of Health to take responsibility for decision-making and daily information sharing to the community. The ethical dilemma that arises in terms of reporting the situation is the conflict between transparently presenting accurate and timely information and the creation of public panic and fear that this may cause in the community.Originality/valueAs a steward for public health, the Ministry of Health was afforded direct responsibility to maintain intra-sector relationships and leadership with other organizations such as political executive organizations, municipalities, military agencies, schools, universities and other public organizations to reach consensus on the best methods of controlling the COVID-19 outbreak. An important ethical issue is found in potential areas of conflict between the therapeutic and preventive roles of the Ministry of Health and those related to public health and the civil administrations.

The atypical presentation of COVID-19 as gastrointestinal disease: key points for primary care.

Since the SARS-CoV2 outbreak in Wuhan, China, in late 2019, the world has been ravaged by a roaring pandemic. Unlike coronavirus SARS-CoV that caused the severe acute respiratory syndrome (SARS) outbreak in 2002, SARS-CoV2 has proven to be more contagious and difficult to control. A key challenge is that the disease presentation can be very variable: patients in the early phase of infection may be asymptomatic, have subclinical symptoms, or atypical symptoms of COVID-19. This, compounded with the lack of easily accessible diagnostic tests, makes it challenging to diagnose COVID-19 in the community. The most common symptoms of patients with COVID-19 are fever (72–88%) and cough (68–83%).1,2 A sore throat may be present in 14–61% of patients, and dyspnoea is usually seen in severe cases and is less frequent (11–19%).1,2 Other non-specific symptoms such as myalgia, headaches, rhinorrhoea, anosmia, ageusia, nasal congestion, conjunctivitis, and haemoptysis have been reported but are comparatively infrequent. However, of significant concern is the atypical presentation of gastrointestinal (GI) symptoms. Early experience in Wuhan illustrated how a cluster outbreak occurred from a single index patient being mistakenly admitted to surgical services for abdominal pain. This resulted in nosocomial spread to 10 healthcare workers and four other patients, all presenting with abdominal symptoms of diarrhoea, nausea, and loss of appetite.3 Non-bloody diarrhoea …

Rapid responses in the emergency department of Linkou Chang Gung Memorial Hospital, Taiwan effectively prevent spread of COVID-19 among healthcare workers of emergency department during outbreak: Lessons learnt from SARS

sLinkou Chang Gung Memorial Hospital, Taiwan has been on the forefront of efforts to manage and mitigate the Coronavirus Disease 2019 (COVID-19) pandemic since 20th January 2020. Despite having one of the largest and busiest emergency departments (EDs) in the world, we have managed to maintain a “zero-infection” rate among our ED healthcare workers through various systematic approaches. The measures implemented include establishing a clear flowchart with route planning, strict infection control policies and regulation of medical equipment, and team-based segregation in the workplace. These strategies, borne of our experience during the severe acute respiratory syndrome (SARS) outbreak, can complement a network of well-trained personnel to enable EDs around the world in successfully mounting an effective defense against new airborne illness while minimizing healthcare personnel casualties.